Labor Positions

Laboring is one of the most difficult times during your entire pregnancy. What’s worse is that you don’t know what you are doing, especially if it is your first baby. No offense, but even as a labor and delivery nurse I didn’t know much about what I was doing. I knew about the different labor positions and such, but I still didn’t know what I was doing.

One thing that is known is that movement during labor is very important and one of the best ways to help get labor progressing. If you sit in the same position for several hours your labor is going to stall, that is why it is important to know the different labor positions and find a few that are most comfortable for you during labor and switch between them. Your nurses and doctor can help you get into position and help you decide which positions will be best for you. It is important, though, to know the different labor positions because some nurses and doctors will keep you in one position and it is usually the position most convenient to them, on your back.

Each position will have it’s pros and cons, and often different positions will help you tolerate the pain of labor differently as well.

There are several different labor positions for you to chose from:

Walking. If you are able to walk during your labor, many women opt for this position for as long as possible. Pros: Contractions often feel less painful, takes advantage of gravity, baby is better aligned with your pelvis, can help reduce back pain or back labor, encourages the baby to drop into the birth canal, may speed up labor. Cons: Cannot be done with an epidural, not recommended if you have high blood pressure, may not be able to be done if you need continuous fetal monitoring.

Standing. Very similar to walking, standing is something else many women try to take advantage of when possible. Pros: Uses gravity, increases the amount of oxygen delivered to the baby, contractions feel less painful while being more effective, helps the baby drop to increase the urge to push, may speed up a labor that has stalled. Cons: Cannot be done with an epidural, hard for healthcare professionals to see the baby.

Leaning or kneeling forward with support. This is a position we use a lot in the hospital if we want the baby to turn. Basically you use a pillow to lean forward on with your butt in the air. You are almost upside down. If your baby is not dropping it may be because she needs to turn. This position can help because gravity will get baby out of the birth canal so she can turn. Pros: Can help turn or shift a baby if needed, contractions are often less painful and more effective, can be done with an epidural if you have help to move in bed, baby is aligned with your pelvis, can help with back labor, easier for your partner or coach to put counter pressure on your back, great resting position, great for pelvic rocking. Cons: Hard for healthcare professionals to help with birth.

Semi-sitting. This is one of the labor positions most often used in the hospital. Basically, when you are in the hospital bed and you raise the head of the bed slightly, this is considered a semi-sitting position. Pros: Comfortable, takes some advantage of gravity, great for resting, can be done with an epidural, easy for your doctor and nurses to check the fetal heart rate and cervical dilation, and easily done in a bed. Cons: Only partially takes advantage of gravity, puts some stress on your perineum, mobility of your pelvis is impaired.

Sitting. Simple and can be done anywhere, this is another common position used in the hospital setting. I don’t think I need to explain this one. Pros: Can be done anywhere, great for resting, uses gravity, can be used with continuous fetal heart rate monitoring, and can be done in a hospital bed with an epidural. Cons: Puts pressure on your perineum, access to your perineum is impossible so you will have to move to have your cervix checked, and you may not be able to use this position if you have high blood pressure.

Sitting on a toilet. This pretty much sums it up. The important part is to not push on the toilet. If you feel pressure like you have to have a bowel movement, tell your doctor or nurse so they can check your progress. Pros: Takes pressure off perineum while still allowing you to sit, helps open up and relax perineum, gets you used to the open-leg position and pressure, uses gravity. Cons: Cannot be done if you have an epidural, the hard toilet seat can be uncomfortable.

Standing supported squat. With this position you will stand up, place your feet shoulder width apart and squat slightly, using either a squatting bar, a wall, or your partner or birthing coach for support. Pros: Helps open up your pelvis by up to an additional 15%, takes advantage of gravity, makes contractions feel less painful, helps your baby line up with the birth canal by lengthening your trunk, and it may increase your urge to push in the second stage of labor. Cons: If you are using your partner for support it will require a strong individual, may be tiring, cannot be done if you have an epidural.

Squatting. Because you are likely to be a little off balance, it is important for you to be supported while squatting. In this position you are squatting a lot lower than in the standing supported squat. You can use a chair, bed, or birthing ball as support by resting your arms on them. Pros: Uses gravity, encourages rapid descent, may help rotate the baby, more freedom for you to shift your weight, allows access to your perineum, great position for fetal circulation, can help increase your pelvic diameter by up to 2 centimeters, requires less effort when bearing down. Cons: Cannot be done if you have an epidural because your legs will not support your weight, can be tiring, your legs may wear out before you are ready to move, harder for you to assist in the birth of your baby if you wish to, can be difficult for healthcare workers to hear fetal heart tones.

Side-lying. You can lay on either side, but often times it is recommended that you lay on your left side if possible. Pros: Great for helping reduce blood pressure, helps increase the amount of oxygen delivered to the baby, great position for resting, easily done with an epidural though you may need some help moving, can help your contractions be more effective, easier for you to rest in between pushes, can slow down a labor that is moving too fast, your partner can help assist in the birth by holding your legs, easier for your partner to see the birth, easier for you to assist in the birth if you want, give healthcare workers access to your perineum, and it may decrease your risk of needing an episiotomy. Cons: Can be hard to hear fetal heart tones, no help from gravity, if no one is available to hold your legs you have to support them yourself, you may not feel like you are doing enough in this position.

These are just the most common positions women find comfortable during labor. The important thing is to make sure you are comfortable and if you have an epidural find a safe position.

Something else to keep in mind is the best thing to do during your labor is to move. This doesn’t mean you have to be walking, but changing positions during labor helps the baby come down and changes how the baby’s head hits your cervix.

Often times the positions the doctors and nurses want you in are not the best position. For example, many times in the hospital you are pushing while laying on your back, and this is actually one of the worst positions for pushing, but with an epidural it is the safest and the one where you have the most sensation to push. If you don’t have an epidural, feel free to ask if you can push in a different position, however you are most comfortable.

What labor position did you find most comfortable during your labor and delivery? Did you change positions a lot? If you had an epidural, how did that affect what position you were in?